ahcccs update september 19, 2012
DESCRIPTION
AHCCCS Update September 19, 2012. Health Care Reform. PPACA expanded Medicaid to 133% of the federal poverty limit on January 1, 2014. Nationally Medicaid is estimated to grow by 16 million lives Create Health Exchange provide tax credit subsidy for individuals from 100% to 400% - PowerPoint PPT PresentationTRANSCRIPT
“Reaching across Arizona to provide comprehensive quality health care for those in need”
Our first care is your health care Arizona Health Care Cost Containment System
AHCCCS Update September 19, 2012
“Reaching across Arizona to provide comprehensive quality health care for those in need”
“Reaching across Arizona to provide comprehensive quality health care for those in need”
Our first care is your health care arizona health care cost containment system
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Health Care Reform PPACA expanded Medicaid to 133% of the federal poverty
limit on January 1, 2014. Nationally Medicaid is estimated to grow by 16 million
lives Create Health Exchange
provide tax credit subsidy for individuals from 100% to 400%
Nationally Exchanges are expected to cover 24 million lives by 2019
State needs to determine who will operate Exchange Made a number of commercial insurance reforms Established Individual Mandate
“Reaching across Arizona to provide comprehensive quality health care for those in need”
Supreme Court Ruling Surprise – Individual Mandate – stands Medicaid – Justice Roberts“We disagree. The court today limits the financial
pressure the Secretary may apply to induce States to accept the terms of the Medicaid expansion. As a practical matter, that means States may now choose to reject the expansion; that is the whole point. But that does not mean all or any will.”
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
What does this mean for Arizona?It is complicatedProposition 204 voter mandateCurrent freeze due to limited resourcesFederal waivers that expire on January 1, 2014 that provided temporary assistance for uncompensated careExecutive seeking input on important decisions re: Medicaid and Exchange
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
Our first care is your health care Arizona Health Care Cost Containment System
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
Population Fiscal SummaryPopulation FPL Est. # State Cost Total
Children 6-18 100-133 44,000 $33 m $124 m
Eligible not enrolled 0-133 137,000 $225 m $656 m
Childless Adult Restoration
0-100 154,000 $170 m $1.4 B
Childless Adult not previously enrolled
0-100 33,600 $37 m $306 m
Optional Parent Expansion
100-133 42,000 $0 $289 m
Optional Childless Adult Expansion
100-133 18,000 $0 $165 m
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
Public ForumsOutlining Executive principles, facilitating stakeholder discussions and gathering input on community perspectives re: ACAFlagstaffPhoenixYumaTucson
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
Process and Timeline for Deliberations Ongoing: Submit clarifying questions to Federal
Government and await further guidance on Federal interpretation of Supreme Court ruling for Medicaid.
August 2012: Update fiscal estimates on State options.
July – November 2012: Engage stakeholders and obtain public input.
November – December 2012: Incorporate final decisions into normal policy-making process.
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
Our first care is your health care Arizona Health Care Cost Containment System
1010
Total AHCCCS Population
“Reaching across Arizona to provide comprehensive quality health care for those in need”
Our first care is your health care Arizona Health Care Cost Containment System
1111
80,000
130,000
180,000
230,000
280,000
Mar May July Sept Nov Jan March May July
Childless Adult Population
“Reaching across Arizona to provide comprehensive quality health care for those in need”
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
AHCCCS AIHP Enrollment
60,000
65,000
70,000
75,000
80,000
85,000
90,000
95,000
100,000
105,000
“Reaching across Arizona to provide comprehensive quality health care for those in need”
AHCCCS Coverage Solutions: Current Status of the AHCCCS Program Current Waivers that end Jan. 2014:
Freeze and coverage for Childless Adults Safety Net Care Pool using local dollars to cover
uncompensated hospitals costs ($332 M program - $150 M paid to date).
KidsCare II allowing coverage for 22,000 children using local dollars.
First-ever funding program to support uncompensated care costs for Indian Health Services and Tribally Operated facilities ($17 M paid to date).
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
Our first care is your health care Arizona Health Care Cost Containment System
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
AHCCCS Coverage Solutions: Building on a Tradition of Flexibility, Partnership Flexibility, partnership are cornerstone of AHCCCS success,
mainly through 1115 Waiver, which: Created first statewide, mandatory Medicaid Managed Care program
(1982); Permitted Home and Community Based Services to allow elderly and
individuals with disabilities to stay at home instead of being placed in institutions for their care (1989).
Allowed coverage for Childless Adults in response to Prop. 204 (2001);
Supported personal responsibility through mandatory copays for Childless Adults (2003); and
Provides State ability to manage program during fiscal crisis.
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
Opportunities for Operational Efficiencies Currently, multiple agencies across state government are
performing the same function of purchasing healthcare services for the State.
Modernizing Arizona’s healthcare infrastructure presents opportunities to consolidate some of these functions.
Streamlining government functions supports best practices, leverages existing capacity and achieves greater efficiencies.
The State could better focus on reform initiatives to align incentives in healthcare, pay for quality of care and not quantity of services, modernize reimbursement strategies (e.g., use of APR-DRGs), and pursue innovation grants.
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
Medicaid Policy Questions What is available in resources to restore Proposition
204? What flexibility will the federal government provide
to the state going forward for this population? What match rate will the state receive for Prop 204 –
standard or enhanced - $1.5 B difference (4 years) What should the state do regarding the adult
population between 100-133% - Exchange or Medicaid?
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
Our first care is your health care Arizona Health Care Cost Containment System
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Health Insurance Exchange Timeframes September 2012: Essential Benefits decision November 2012: Submit State’s Intent
regarding Exchange to HHS Secretary January 2013: HHS Secretary Certifies Exchange July 2013: Systems Readiness Testing October 2013: Exchange enrollment begins January 2014: Exchange coverage begins January 2015: Exchange must be self-sustaining
through user fees, assessments or other funding sources
“Reaching across Arizona to provide comprehensive quality health care for those in need”
Exchange Tax Credits Law provides for refundable, advanceable
Credits Up to 133% FPL – 2% of income 133-150% FPL – 3-4% of income 150-200% FPL – 4-4.63% of income 200-250% FPL – 6.3-8.05% of income 250-300 FPL – 8.05-9.5% 300% + - 9.5%
“Reaching across Arizona to provide comprehensive quality health care for those in need”
Health Insurance Exchange: Funding State v. Federal Exchange operation
considerations: Customer Support Competition and Choice AHCCCS eligibility determination Start-up Funding
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
Other Issues
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
Our first care is your health care Arizona Health Care Cost Containment System
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Dual Members DemonstrationUnprecedented historical opportunity to improve care April – Presentation to CMS and OMBMay - Meetings with
1. CMS Administration 2. Congressional Staff3. MEDPAC/MACPAC
June – Hosted California Staff July – Congressional TestimonyConcerns expressed include (non CMS)
Speed – Size – Health Plan Capacity – Unresolved Issues – Medicare Principles
Current model is fragmented, unsustainable and results in lack of accountability and sub-optimum outcomes
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Arizona Dual Eligible Demonstration Proposal Arizona 1 of over 20 states to submit proposal Arizona has proven success of alignment Submitted to CMS on May 31, 2012 3 Year Demonstration Goal – Statewide move from 40,000 integrated
members to 100,000 3 way contract – CMS – State – Plans Still unanswered questions –requires flexibility
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KidsCare Program KidsCare II
Originally 21,000 slots Slow startup allowed for additional enrollment – 22,200 currently
enrolled Cap instituted September 7 1-1-14 end date
New Prop 204 Sales Tax Directs $25 million to KidsCare (potentially a “KidsCare III
program) Additional funding not really needed, since ACA provides 99%
federal match for KidsCare
“Reaching across Arizona to provide comprehensive quality health care for those in need”
Care Coordination Strategies Care Management Coordinator AHCCCS working with 3 populations with Inpatient
stay Long Term Care – contacting tribal case manager Newborns – contacting moms to coordinate pediatric
visit Diabetic Patients – connecting member back to I.H.S
& 638 system
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
Implementing Legislative Changes Breast and Cervical Cancer program
Allows screening by a broader array of providers Expected to increase program enrollment
Ambulance Rates CY 2013 rates at 68.59% of ADHS as of Aug 2 (proposed
rule) Future rates determined through collaborative stakeholder
process that includes: Predictability Limited annual impact Potential acknowledgement of changes in uncompensated care
“Reaching across Arizona to provide comprehensive quality health care for those in need”
Outstanding Waivers Integration Waivers
CRS members Individuals with SMI – Maricopa RBHA to
provide physical health and behavioral health Nursing Facility assessment
“Reaching across Arizona to provide comprehensive quality health care for those in need”
Hearings OALS and OAH implementing plan to reduce
backlog Of 1237 cases:
340 vacated 403 withdrawn 442 set for prehearing 52 received hearing
“Reaching across Arizona to provide comprehensive quality health care for those in need”
Other Issues Managed Care RAC RFI – closed Sept 5,
2013 - 7 responses received – currently under review
State Innovation Models (SIM) grant Governor’s Office would lead application Concerns regarding:
Resource diversion from priority projects Coordinating various stakeholders/players Breadth of scope
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
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Other Issues Numerous federal efforts around updating and
improving quality measures CHIPRA Core – Comprehensive Well Child Core – Adult
Core - Dual Eligible – Multiple Chronic Disease – Meaningful Use – CMS Access Measures
HIT – looking to leverage ARRA investment 986 EP - $20 m – 47 Hospitals - $56 m
New IP Payment methodology – All Payer Refined – Diagnosis Related Groups (APR-DRGs)
“Reaching across Arizona to provide comprehensive quality health care for those in need”
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Other Issues Audits and Reviews
Sunset Audit – 2 of 4 reports complete Eligibility 1.1% Error Rate – see attachment
Medicare Part B Payments – Disallowance PERM Review RAS Recovery Audit CMS ALTCS Review – GAO Managed Care Review
Nursing Facility Assessment Fee Legislation
“Reaching across Arizona to provide comprehensive quality health care for those in need”
NAMD 501(c)(3) entity to facilitate dialogue among
states, develop consensus on critical issues, represent Medicaid directors in national policy debates, and provide technical assistance to states.
Medicaiddirectors.org
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
State Personnel Reform Modernized state management of employees
to increase productivity, attract talent and retain high performing employees.
Certain current employees and all new employees will have “uncovered” status.
State agencies are implementing over the next year.
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“Reaching across Arizona to provide comprehensive quality health care for those in need”